Return on investment of pharmacists' services among non-hospitalized patients: A scoping review

Abstract

Background: As pharmacists' role has evolved to encompass medication management services, there has been limited expansion of insurance coverage of these services. Investment in services by employers and insurance plans may be limited due to concerns regarding financial viability and an unclear return on investment (ROI).

Objectives: This scoping review described reported ROI of studies evaluating pharmacist driven medication management services among non-hospitalized patients. A secondary objective was to describe key details of included studies that could impact the ROI analysis.

Methods: Reporting for this scoping review was conducted in consultation with the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR). Search was conducted in PubMed, Embase, and Web of Science from inception up to the search date. Two-stage process in the Covidence web platform was utilized to screen and identify studies. For studies to be included, the study (1) needed to be a pharmacy service provided to a non-hospitalized patient, (2) needed to have evaluated the effect of the intervention on medical costs or medical and prescription costs, and (3) needed to report ROI as an outcome. Extracted data included year of publication, study design, follow-up, or observation period, setting, sample size, perspective of analysis, inclusion and exclusion criteria, type and description of intervention, and details and outcomes of economic analysis.

Results: There were 28 studies included. ROI ranged from -3% to 504 % among the nine studies that reported ROI as percentages. ROI ranged from $1.29 to $18.5 per dollar spent on the pharmacy service among the 19 studies that reported ROI as a ratio. Only one study reported a negative ROI. A total of five studies did not report how ROI was calculated.

Conclusion: There was a largely positive return on investment of pharmacists' services provided in outpatient settings from the perspective of payers and employers. However, a lack of consistency and clarity in the reporting of study characteristics and economic outcomes was noted, which may partly limit the generalizability and utility of economic analyses to support the implementation of new pharmacists' services in other settings.

Keywords: Economic outcomes; Pharmacist services; Pharmacoeconomic; Provider status; Return on investment.